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Monday, October 28, 2013


Well, even The Health Care Blog is continuing to devote a ton of bandwidth to the travails of the Affordable Care Act rollout, so I guess I'll stay with the riff a while longer, and maybe get around to tying it all back around to actual "Health Information Technology" (the clinical pieces that is -- EHRs and HIEs, all beset with their own chronic shortcomings).

This week the DC Carnival kicks off with two congressional hearings: CMS head Marilyn Tavenner appears before the Ways and Means Committee tomorrow, followed by Wednesday's Main Event Match between HHS Secretary Sebelius and the House Energy and Commerce Committee. I will be breaking out the popcorn for both of those. But, first...

The Power of Photoshop Compels Me.

Lifted the Susan Collins quote from this paper:
Kludgeocracy: The American Way of Policy
Steven M. Teles, Associate Professor of Political Science, Johns Hopkins University
December 2012

The last thirty years of American history have witnessed, at least rhetorically, a battle over the size of government.1 Yet that is not what the history books will say the next thirty years of American politics were about. With the frontiers of the state roughly fixed, the issues that will dominate American politics going forward will concern the complexity of government, rather than its sheer size....

...Martha Derthick shows that the confused joint administration of the flood protection system of New Orleans played a vital role in the system’s failure during Hurricane Katrina.6 Derthick quotes Sen. Susan Collins as having found that there was “confusion about the basic question of who is in charge of the levees,” an inherent problem given our pervasive, kludgey interweaving of federal and state responsibilities. Because administering programs through intergovernmental cooperation introduces pervasive coordination problems into even rather simple governmental functions, the odds that programs with shared rather than solo responsibility will have unintended consequences and sluggish administration are, inevitably, high.
Kludgeocracy is also a significant threat to the quality of our democracy. The complexity that makes so much of American public policy vexing and wasteful for ordinary citizens and governments, however, is also what makes it so easy for organized interests to profit off the state’s largesse...
The Causes of Kludgeocracy
The costs of kludgeocracy, therefore, are considerable. To do something about it, however, requires that we understand why American politics turns to kludgey solutions so regularly.
A condition as chronic as kludgeocracy is inherently multi-causal, but the key interlocking causes of kludgeocracy are the structure of American institutions, the desire to preserve the fiction of small government while also addressing public problems, and the emergence of a “kludge industry” that supplies a constant stream of complicated, roundabout solutions. I will address each in turn.

We were all taught in school that American institutions were designed to constrain the growth of government. This is, of course, why those on the right tend to defend our founding institutional heritage, while many liberals as far back as the Progressive Era have voiced considerable skepticism. But there are reasons to be skeptical of the idea that federalism and the separation of powers limit the growth of government, since a huge pile of political science scholarship shows that when we look beyond spending and taxation and focus on policy tools that the United States has historically relied on more heavily, such as regulation, litigation, and tax expenditures, the activity of the American state is not starkly different than other industrial countries.

American institutions do, in fact, serve to constrain the most direct forms of government taxing and spending. But having done so, they do not dry up popular or special interest demands for government action, nor do they eliminate the desire of politicians to claim credit for new government activity. Public demand, when prevented from flowing directly, does not disappear. Instead, it spreads out in complicated, unpredictable ways...
"administering programs through intergovernmental cooperation introduces pervasive coordination problems into even rather simple governmental functions."

Yeah, and add to that the myriad private sector players intextricably woven into the tapestry (e.g., the AHIP crowd), and the potential for adverse unintended consequences rises materially.

Speaking of private sector players (with a PPACA contract, to be sure), this is one of today's headlines.
Obamacare Websites Limited by Verizon Data Hub Failure
By Alex Wayne - Oct 28, 2013 11:13 AM PT

The Obamacare data hub that routes applicant information to websites run by the federal government and 14 states resumed service after failing yesterday.

The data hub center, operated by Verizon Communications Inc. (VZ)’s Terremark unit, lost connectivity after workers tried to replace a broken networking component. As of 7 a.m. today New York time, the hub was “fully operational,” according to an e-mailed statement from Joanne Peters, a spokeswoman for the U.S. Health and Human Services Department...
The wags are out in force, snarkily arguing that that the feds should simply have turned the entire PPACA HIX rollout to high-tech commerical vendors such as Amazon or Google.



CMS's Marilyn Tavernner testifies today. Also, note the little "in case you missed it" headline. MSNBC is all over that this morning.

President Obama repeatedly assured Americans that after the Affordable Care Act became law, people who liked their health insurance would be able to keep it. But millions of Americans are getting or are about to get cancellation letters for their health insurance under Obamacare, say experts, and the Obama administration has known that for at least three years.

Four sources deeply involved in the Affordable Care Act tell NBC News that 50 to 75 percent of the 14 million consumers who buy their insurance individually can expect to receive a “cancellation” letter or the equivalent over the next year because their existing policies don’t meet the standards mandated by the new health care law. One expert predicts that number could reach as high as 80 percent. And all say that many of those forced to buy pricier new policies will experience “sticker shock.”...
Buffeted at every turn. Gonna be an interesting week.

While we await today's congressional hearing festivities...


What GAO Found
Hospitals and health care professionals, such as physicians, were awarded a total of approximately $6.3 billion in Medicare electronic health records (EHR) incentive payments for 2012, which is more than twice the $2.3 billion awarded to hospitals and professionals for 2011. Almost half of eligible hospitals and less than a third of eligible professionals received Medicare EHR incentive payments for 2012.

For 2012, the 2,291 hospitals that were awarded payments represent 48 percent of the eligible hospitals and an increase compared to 2011, when 777 hospitals, or 16 percent of those eligible, were awarded payments. Nationwide, 72 percent of hospitals were new to the program; that is, they were awarded an incentive payment for the first time. Participation varied among hospitals with certain characteristics. For example, acute care hospitals were nearly twice as likely as critical access hospitals to have been awarded an incentive payment for 2012. In addition, hospitals in rural areas were 3.1 times more likely to have been awarded an incentive payment for 2012 compared to 2011, a slightly greater increase than for hospitals overall.

Additionally, 183,712 professionals were awarded payments for 2012, which represents 31 percent of the eligible professionals and an increase compared to 2011, when 58,331 professionals, or 10 percent of those eligible, were awarded incentive payments. 

Nationwide, 75 percent of professionals that were awarded an incentive payment for 2012 were new to the program. General practice physicians were 1.5 times more likely than specialty practice physicians to have been awarded an incentive payment for 2012. In addition, professionals with the lowest total amount of Medicare Part B charges were 3.3 times more likely to have been awarded an incentive payment for 2012 compared to 2011, which was a slightly greater increase than for professionals overall.

Why GAO Did This Study
Widespread use of health information technology, such as EHR, has the potential to improve the quality of care patients receive and reduce health care costs. The Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act of 2009 (Recovery Act), among other things, provided funding for various activities intended to promote the adoption and meaningful use of certified EHR technology, including the Medicare and Medicaid EHR programs. Starting in 2011, these programs have provided incentive payments for hospitals and professionals that demonstrate meaningful use of certified EHR technology and meet other program requirements established by the Centers for Medicare & Medicaid Services (CMS). This report provides information on certain providers, including hospitals and professionals, that were awarded Medicare EHR incentive payments for 2011 and 2012. Using data from CMS and other government and private sources, GAO determined the number and percentage of eligible providers awarded Medicare incentive payments; determined the amount of Medicare EHR incentive payments awarded to providers; and examined the characteristics of providers that were awarded Medicare EHR incentive payments.
Complete PDF copy of the 50 page report here.


And, now...


Not much to say. About 10 minutes of partisan speechifying for every actual question posed to the witness (and with many of the adversarial questions coming from the Republican members being simply repetitive, banging away at the same point). Ms. Tavenner gave as good as she got. The Big Prize is tomorrow, when HHS Secretary Sebelius testifies before the House Energy and Commerce Committee.

Nice summary here.
Dem congressman to GOPer at Obamacare hearing: “Are you really serious!?”
Rep. Bill Pascrell absolutely loses it during a House hearing on Obamacare

While today’s Obamacare hearing may not have shed much light on the workings of the law, it did teach us this much: New Jersey Congressman Bill Pascrell likes to stand up when he yells at Republicans.

And during Tuesday’s hearing on Obamacare, that’s just what he did. First Pascrell pointed his finger at Republicans for their unwillingness to cooperate with the implementation of Obamacare, contrasting the GOP’s behavior over the past three years with that of the Democratic Party in the years following the passage of George W. Bush’s Medicare Part D.

“What did we do [after Medicare Part D passed]? We went back to our districts, and we told our seniors that although we voted no, we personally believe, and will work with the Bush administration, to make it work. That’s what we did!”

Pascrell then stood up and yelled at the Republican members of Congress attending the hearing, “And how many of you stood up to do that? None! Zero! Zero!”

Later in Pascrell’s harangue, the New Jersy congressman asked Republicans what they would say to those with preexisting conditions in the event that Obamacare was repealed. “What are you going to do about the approximately 17 million children with preexisting conditions who can no longer be denied health insurance coverage?” Pascrell said. “We want to go back and want to say you are no longer covered any longer — are you going to tell the parents of those kids?”...



Showtime. Sworn in under Oath, 18.USC.1001.



Ranking Member Rep. Waxman, in his opening statement, asks the Republicans to stop hyperventilating.

No chance. Rep. Marsha Blackburn (R-TN) could not be more hostile right out of the gate.

Slate's John Dickerson writes
When launched with the fanfare and success of a North Korean missile, the president insisted that Obamacare was more than a website. The website might be a mess, but the underlying product was sound. Now, it's Republicans who are using this exact phrase. Like the president, GOP leaders want people to focus on the larger law. You can fix a website, they say, but you can't improve the law.

What started as a website debacle is growing into a relitigation of the underlying operation. The Affordable Care Act passed with cracks and inconsistencies that are now re-emerging in the context of the website's bad launch. In some cases that simply gives Republicans new lines of attack. In others, like this argument over keeping your old health care, the failure of the site is weakening the administration's ability to engage in those old debates.
Another gem, from
Federal CIO Steven VanRoekel spouts perky inanities about the wonderfulness of and is so clueless about software development it makes my head hurt.
I present to you this gem of confusion.
“We should all be proud of the fact that something this complex, this integrated to legacy systems — and there are mainframes out there this thing hooks to — was done at Internet scale and taken online in this way. Just the fact that we have transactions moving between agencies using open data, using modular development, using technology in a way that moves really from a 19th and 20th Century government paper approach to an online approach is something we all should be proud of,” VanRoekel said.
Oh my God, you mean the online can actually talk to mainframes? This staggering new development has only been going on since, oh, shortly after the birth of the Internet. Modular development of software, which he thinks is cutting edge, has been around for 50 years or so. I’ve no clue what he means by ‘open data.’ I suspect he means ‘open source.’ For the head techie of the US government to not even get that basic concept and jargon correct in deeply troubling. And ‘Internet scale” is…?
"Could you imagine the [Obama] campaign, if their website had been like this during the campaign? You think they would have stood for that?"
"The cost of fixing an error in an application increases as much as ten times if it has to be rectified in a production environment. The risks associated with inadequate testing, and consequently with insufficient quality, are rising, particularly with the increasing complexity of multiple and inter-dependent applications. Testing is a key phase of any project, and if conducted the right way, gives a business owner an objective view of the quality of the product, increases control, and reduces risk and cost. Based on the experience we’ve developed implementing some of the largest independent testing programs for the Federal government and CMMI® best practices, QSSI built an extensive Software Quality Assurance practice that manages requirements and quality with complete traceability from inception to completion."
 Right. QSSI, recall, is one of the prime contractors for the HIX rollout -- one now pointing fingers at everyone else. From their "Software Quality Assurance White Paper" (PDF) -
People and businesses rely on automated systems to deliver information quickly and accurately through the digital processing of complex tasks. As business requirements become increasingly intricate, systems begin to intersect and overlap themselves, increasing the systems’ complexity through the introduction of new factors and information. Now more than ever, we are moving towards an era of interconnectivity. By granting separate systems permission to shares utilities and information, we will be able to develop business intelligence and make connections that were previously unattainable. This level of computing is only sustainable through commitment to Software Quality Assurance (SQA). Organizations rely on developers to monitor and scrutinize the software engineering processes and methods used throughout the Software Development Life Cycle (SDLC) to develop their systems and assist them in the day-to-day operation of their business.
QSSI’s dedication to process improvement and standardized methods has directly impacted our ability to craft SQA solutions for our clients. As a CMMI® Level 3 organization, our standards and methodologies are well-defined and have been established over the course of our dynamic history. These standards and processes, coupled with the subject matter expertise gained through our provision of software development services to our clients, have cultivated an in-house SQA Practice Center that is comprised of best practices, expertise, techniques, supporting tools, and proven processes. Our ability to implement our SQA expertise into the SDLC assures that our clients’ needs are met and they can rely on the software we’ve worked with them to develop.

Full Life Cycle Testing
The goal of any system and its software is to deliver a solution to a targeted user group. In today’s competitive marketplace, it is essential that organizations are able to balance their ability to develop quality software and release that software in a timely fashion. Full Life Cycle Testing (FLC) is vital to those organizations that refuse to compromise on the quality of their product, yet remain driven to implement their solutions quickly.

QSSI Life Cycle Testing solutions expertly identify the necessary test activities essential to the success of the software and when the best time is for those activities to be executed. Our SQA Practice Center is the repository for our best practices and testing solutions that can be quickly tailored to meet the testing needs of our clients. Our deep understanding of the time-sensitive nature of testing inspired us to create a comprehensive testing approach that ensures requirements are explicitly defined and logically consistent throughout the Software Testing Life Cycle (STLC), and that the design code meets the established requirements.
These people are full of crap. Their "SQA" declarations are worthless. Marketing department platitudes, given their sorry performance on the initiative. There may well have been contract and political timeline inhibitions that led to their part in this mess, but they should have had the corporate courage to have blown the whistle prior to the launch. That they will likely be paid hundreds of millions of dollars anyway ought put everyone's hair on fire.

BTW- I wonder how many people know that CSSI is now a subsidiary of United Health Group (specifically the OptumInsight part of the UHG org chart)?


Well, the hearing is over. Ended at 1:35 Eastern time. It was not as contentious as I thought it might be. Sebelius acquitted herself well, and bought herself some time, though if HHS misses its self-declared deadline for fixing, the calls for her head will reach deafening levels.

Interesting that she testified that CSSI has been given the new task of basically QA'ing their own work -- and will apparently be paid for it in addition to their existing contract. i.e., "Fee-For-Service (FFS)," like, say, when a hospital releases a patient only to have them re-admitted within a month, incurring new charges. CMS has vowed to quit paying for sucj re-admits, under "P4P" (Pay For Performance).

How comforting.

JAMA Forum: With a Bumpier Rollout Than Expected, Better Transparency Needed on Health Insurance Exchanges

As we all now know, the start-up of the federally run insurance exchange websites and the first few weeks that the exchanges have been operating have been extremely bumpy—certainly bumpier than anyone (including me) had been predicting.

The experience of the District of Columbia and the 14 states that are running their own exchange websites has been mixed but generally better than that of the federal exchanges. Jeffrey Zients, the former senior person for management at the Office of Management and Budget who has been brought on to oversee the Obama Administration’s clean-up efforts, has publicly promised that the federal exchanges will be running smoothly for “most users” by the end of November.

A variety of reasons have been offered as to why the federal exchange website has been so dysfunctional—frequently crashing, sending repeat error messages partway through enrollment sequences, and so on. The administration initially attributed the problems to higher-than-anticipated volumes of users accessing the sites. Unfortunately, volume was, at most, only a contributing factor among many other problems. A statistic reported by Phil Galewitz of Kaiser Health News clearly characterized the early experiences: it took Galewitz 17 days and 63 attempts to enroll...

The concern is that with the difficulties encountered to date, the people most likely to doggedly persist through the process are the ones who need insurance the most—those who used to be in high-risk pools and others who know they need medical insurance because of their health needs. The worry is that the expected “low users” of health care—the “young immortals” or others who are otherwise healthy and likely low users—also need to sign up for insurance to get the risk pool at a manageable level. Whether they will be as persistent in making it through the enrollment process is unclear.

In the meantime, the federal government should take a lesson from the states and their willingness to share information about enrollees’ experiences in their exchanges. On the state exchange websites, it is easy to see how many people have visited, viewed options, set up accounts, and enrolled in private insurance or in Medicaid.

For reasons known only to the administration, the federal government has adamantly insisted it will not share information on actual private plan enrollment until at least mid-November. This type of continued stonewalling is a really dumb idea—not the least because it makes people wonder what else the government isn’t telling them.
Well, yes, "transparency" would be nice. Including, say, transparency as to the relative natures of the bugs in the system. System bandwidth (including server inadequacy)? Code logic flaws (exacerbated by uncoordinated modular coding among various contractors)? "Fault tolerance"/error trapping inadequacies?
Back in the 1980's I wrote apps in an environmental radiation lab in Oak Ridge, programs to be used in radionuclide contamination and dose exposure assay operations. Probably 90% or more of my code was devoted to "idiot trapping" -- i.e., making sure that lab techs couldn't enter incomplete or otherwise bad data via the user interfaces. The actual computational code -- the algebra -- was maybe 1% or less, with the remaining few percentages being devoted to results reporting output and RDBMS capture.
How about data errors? I've not heard much at all these past two weeks about the extent to which bad data in the various distributed databases comprising the under-the-hood guts of have contributed to this fiasco. Your programming logic and module interfaces may be airtight, but you cannot code your way out of bad data already resident in your far-flung RDBMS -- other than to write expensive, laborious remediation code that goes through the data repositories and rectifies the ID'd and suspected errors in the tables ("data scrubbing"). Problematic, that idea.

I'll have some detailed thinking on that in my next post.




More to come...

Thursday, October 24, 2013 in the Congressional crosshairs

"Testy," "acrimonious" would materially understate the contentiousness of the House hearing, which I am following live online as I write. I would not want to be these CGI Federal and QSSI people right now.

I'm about 2/3 of the way through the Jeff Bezos/ bio as of now. Highly recommended read. I bought the hardbound edition at CostCo, and will probably also spring for the Kindle edition ($10.99) as well. Worth it for the easy citation examples I will proffer. There are lessons that could be applied to this jaw-dropping HIX CusterFluck.

Below, one of my high school friends just posted this on Facebook.

Bill is a semi-retired multimillionaire who made his money the old-fashioned way. He built a wildly successful international periodicals distribution business, sold it for a huge cashout, and now dabbles as a "hard money lender." We played together in our Somerville NJ dance band in the early 1960's. Great guy. Smart guy. Still plays the sax (as I do on guitar, episodically).

He hates "ObamaCare" (and the federal government more generally). We joust online every now and then, and I usually fold after things get "elevated" by replying "so, how about those Red Sox?"


The Big Prize in the unfolding "reality show" psychodrama. I'm sure she's rehearsing her lines.


"It's not our fault. That was not our responsibility. It's CMS's fault. We did everything we could. We'll get back to you on that..."
Stay tuned. Pass the popcorm...

Contractors point fingers over ObamaCare botch, blame gov't for poor testing

The finger-pointing was in full swing Thursday at a tense Capitol Hill hearing where the contractors behind the botched ObamaCare website defended their work and claimed the government failed to properly test the system before launch.

The contractors faced tough questioning from lawmakers on both sides of the aisle, who voiced frustration with the weeks-long problems surrounding the federal hub. Lawmakers cast doubt on attempts by contractors, who were paid millions, to claim they were not responsible for many of the site's problems. Top contractor CGI Federal revealed it was paid $290 million in taxpayer funds...
Yes. I've just watched about 4 hours of predictable finger-pointing and blame-deflecting.


The Midterm Grade for
By UWE E. REINHARDT for The NY Times

...President Obama taught constitutional law at the University of Chicago Law School. How would he have graded a student’s performance on, say, a term paper or test that the professor viewed as “unacceptable,” especially when there was “no excuse” for the paper’s deficiencies?

One would hope that the grade would have been F, even under modern grade inflation. I certainly would affix that grade to such inexcusably deficient work.

But who exactly should be assigned the F for the troubled rollout of

At the Rose Garden ceremony, President Obama noted, “There’s no sugar coating it, the Web site has been too slow, people are getting stuck during the application process, and I think it’s fair to say that nobody is more frustrated by that than I am.”

That makes it sound as if the president was surprised and then angered by the poor performance of Indeed, in a television interview Tuesday with Dr. Sanjay Gupta on CNN, the secretary of health and human services, Kathleen Sebelius, appears to suggest as much, even though is reported to have crashed days before the start on Oct. 1 when only 100 people tried to register simultaneously.

As someone who has lectured on corporate governance and served on corporate boards, I find Secretary Sebelius’s statement astounding. Is this how the project was managed? They knew the Web site was not working and yet decided to go ahead with it anyway, without the president’s personal O.K. for so strategic and risky a decision?

Once elected, a president becomes chief executive of a giant federal enterprise. Anyone familiar with corporate management would have thought that for as ambitious and technically a complex project as the initial rollout of – so important to many uninsured Americans and so politically important to the White House – the chief executive would have remained in very close touch with the management team overseeing the project and thus would have been briefed daily or at least weekly on the progress of the project and especially on any problems with it.

Woe to the members of the management team in a corporation if problems with a project are hidden from the chief executive when they become known, exposing the chief executive to embarrassing public relations surprises. Heads would roll. The board, however, would assign the blame for such problems not primarily to the management team and instead to the chief executive himself or herself. He hired and supervised the team.

From that perspective, the blame for the disastrous rollout of goes to its entire management team, to be sure, but primarily to the chief executive on top of that project. In my view, not only the proverbial buck stops on the chief executive’s desk, but, for the management of this particular project, the grade of F goes there as well...
Ugh. I wonder whether HHS Secretary Sebelius survives this mess, all her dismissive talk notwithstanding. I'd bet money that she doesn't. Maybe not straight away, but this is astonishingly inept. The President is not going to fire himself.


One of my Health 2.0 Refactored Conference shots
Wonkbook: How looks to a health IT pioneer
By Ezra Klein and Evan Soltas, Updated: October 25, 2013

If you watched Thursday's monkey court -- sorry, heath care hearing, you didn't learn much save this: Democrats have a policy interest in fixing's problems but a political interest in downplaying their severity. Republicans have no interest in fixing the problems but a strong interest in publicizing them. The result is that the party that wants to talk about what's wrong with doesn't want to actually figure out how to fix it while the party that wants to fix it doesn't want to talk about it.

The assembled contractors weren't any more informative. They retreated behind a haze of acronyms and finger pointing and uncomfortable silences.

So for Wonkbook this morning, I spoke to someone who actually is more informative. Fred Trotter, the author of "Hacking Healthcare," is a pioneer in the health IT world. He's someone who actually does the kind of cutting-edge software development using the kind of cutting-edge techniques that people feel needed. A lightly edited transcript of our conversation follows.

Ezra Klein: Are you surprised by the rollout of
Fred Trotter: I’ve been in health IT for years. I have this data set where I look at the health-care system as a whole and model it out. I have experience as a government contractor working on VISTA for the VA. So it doesn’t surprise me at all. What you need to run a massive consumer web site is the latest in horizontal scaling and that’s hardly approved software for the federal government. The federal government has very conservative mechanisms for purchasing off-the-shelf software and creating new software. That puts a lot of constraints on them.

EK: Explain what horizontal scaling is.

FT: When you get a certain amount of traffic going to any site on the internet a single computer can’t handle it. In order to handle tremendous amounts of traffic you have to have more than one computer sharing a task. At modern sites like Amazon and Ebay and Google, the main innovation they’ve pioneered is using lots of computers at the same time to answer one query to the web site.

But it’s a different problem for different tasks. If the federal government wanted to sell billions of books online that’s fairly understood. They could just look at Amazon. But they’re trying to do something entirely new. And that means that what they’re talking about is the invention of something new. The way Congress looks at software is that there are these sites that do these amazing things and we should do that, too. They don’t realize that a tremendous amount of invention has gone on at these scaled web sites to handle these processes.

EK: I’ve been reading the new biography of Jeff Bezos, as he is now my master and overlord, and an ongoing theme is that Amazon’s tech had to keep being reinvented as the site grew. And that process, it’s clear, was really hard, and getting it right was really important to why Amazon and not some other e-commerce site won. How much more difficult of a problem did the federal government give itself when they tried to unveil a single piece of tech that could handle huge traffic on day one?
FT: They screwed themselves twice. The first thing they did that was very foolish was to go at scale. Usually when the government understands the problem of that they do things in phases. They didn’t draft everyone for Vietnam all at once. That’s the model they should’ve used. They should’ve said people born in January can now get health insurance. Then it should’ve expanded to everyone born in the first quarter. And so on. But they presumed scale was easy. That was the first mistake. The second was assuming invention was easy. And scaling something that hasn’t been invented yet -- that’s technological suicide...
Interesting. I'm 100 pages shy of finishing the Bezos book. Will have some observations.

Just in... will work smoothly by end of November, government pledges
Maggie Fox NBC News

The troubled federal health insurance website will be fixed by the end of November, giving uninsured Americans two weeks to get signed up in time to have health insurance by the earliest possible date, officials pledged Friday.

One of the main government contractors, QSSI, has been assigned to oversee the fix, says Jeff Zients, the newly appointed chief White House economic adviser who’s been tasked to fix the logjammed website.

“We are confident that by the end of the November, will be smooth for the vast majority of users,” Zients told reporters on a conference call.

“Over the last week we worked with a team of experts to conduct an assessment of the overall state of the site," Zients said. They lent "fresh eyes" to the problems plaguing the site. “The system is getting better,” he added. “There is a lot of work to do but is fixable.”...
We shall see.


On the cusp of Halloween...

Why We Need a Witch Hunt
It is the only way we have a shot of settling a big debate: Can government do big things?
By John Dickerson, Slate

Washington think tanks your moment has arrived! is a mess and someone must chronicle exactly what went wrong. The press is trying, of course, but we also must cover the aftermath—the parade of predictable behavior that obscures more than it illuminates. Did you see the hearing in the House Energy and Commerce Committee yesterday? Despite the best efforts of Chairman Fred Upton, between the grandstanding, confused questions, and the witness fog machine, it's a wonder anyone got out alive. Meanwhile, Republicans are pointing fingers, placing blame, and otherwise showing disgust that a program that they have tried to kill is being run so badly. (Perhaps they're jealous that the administration is better at undermining Obamacare than they are.) Administration officials, on the other hand, are caught between covering their backsides, spouting plumes of happy talk, and hiring more people to collect the springs and sprockets from the launch pad where the whole thing went kaput. On Friday, officials in charge of the #techsurge said that would be running smoothly by late November, two months after the launch.

Here's why a controlled witch hunt is needed: This episode is about much more than a website. That’s true with respect to health care, as Ezra Klein points out, and it’s also true because there are big national issues at stake that have nothing to do with the specific issues of sickness and health. Can government do big things? Sen. Lamar Alexander famously said during the health care debates, "We don't do comprehensive well"—meaning that any law that is big and complicated will fail. Is that right?

Alternatively, has partisanship and gridlock created a situation where small flaws in a law can't be fixed through tweaking legislation because such legislation can never pass? Is there something about complex technology that confuses the bureaucracy? Is the procurement system nuts? Does the political nature of all administration activity mean that no one is capable of reporting that the launch of a key element of the president's signature legislation is going to throw a rod? Some of the states seem to be doing just fine. Is that because they are smaller enterprises or because the people working on state health exchanges have more flexibility?...
...This [witch hunt] project should be one everyone loves. Only the most devout libertarian doesn't want the government to do anything. Those who want a smaller government should still want it to operate efficiently. Liberals, and people like the president, who believe in smart government, should be pushing hard for answers. If they're not interested in a thorough deconstruction of what went wrong for policy reasons, they should care for political ones. is now a very good excuse for anyone who wants to oppose an activist federal government. All a lawmaker has to say is that they don't want the same government that ran in charge of X, where X is anything you want to see stopped in its tracks.

Right now, no one in this drama is trying to learn from the mistake. That's understandable, but it also guarantees that the mistake will be repeated.
Not sure I agree with the inflammatory, made-for-Ted-Cruz "witch hunt" characterization. But, it's like putting "sex" in the title as an attention grabber, I guess.


This is pretty funny.


More to come...

Monday, October 21, 2013

DATA: Meaningful Use Attestation and 2014 CEHRT updates

Drawing on the latest ONC and ONC+CMS data, we see the following:

Incentive payments up from $15.9 billion to $16.2 billion, not much of a relative increase,m as was the case last time. Unsurprising this time of year for those on calendar year MU.

Equally interesting are the merged ONC+CMS data tabluting attestations by vendor and product.

Presenting here only to top 20 as ranked. Epic continues to rule. But, eClinicalWorks has done a great job, coming in 3rd, amid much larger players. And, the free Practice Fusion ranks 10th.

Below, the data dictionary for the ONC-CMS aggregated data.

Lots of ways to stratify/"peel back the onion." Geographically granular to the state level, but many other perspectives to be had as well. Had I SAS or Stata install I'd probably have already sliced 'n diced these data 16 ways to Sunday, just out of empirical curiosity. Excel pivot tables are OK, but clunky and slow in comparison.

Top Attestors by specialty below.

Note: "PEP" here in my tally means "Priority Eligible Provider," i.e., those who can engage the RECs for ONC-subsidized technical assistance. Also often referred to as "PPCPs."

Moving on to the 2014 CEHRT data. A lot of concern has been expressed regarding the extreme paucity of 2014 ONC certifications to date. e.g.,

A mere 20 vendors certifying only 27 complete ambulatory products at this point. There are 1,767 ONC 2011 MU complete systems certified to date.  (In fairness, that's an overcount, given that many vendors certify successive releases of the same product. I'd need to run a "PROC SORT; by EHR Product NODUPES;" on the data in SAS for a quick, clean boiled-down complete tally. Still, there are hundreds.)

UPDATE: a quick screen scrap and Excel dump shows the Cert redundancies and overcount problem (2011 cert data), given the CHPL certs for every major and minor version releases.

(Note: the material difference between eCW "9" and"9.0" escapes me. It's just what I found there.)

It's even more sparse on the inpatient side. Below, screen-snipped directly from ONC CHPL:

Only eight vendors certifying complete inpatient EHRs.

What, me worry? Stage 2 Year 1 has already commenced for certain Eligibles operating on the federal fiscal year.

The recently added, weasely "Combination of 2011 and 2014 Edition" is pretty vague.
You have selected the ‘Combination of 2011 and 2014 Edition’ EHR certification criteria for attestation. You can use EHR technology that is certified to 2011 edition certification criteria AND/OR the equivalent 2014 edition certification criteria to generate CMS EHR Certification ID that is submitted to CMS as part of attesting to meaningful use of certified EHR technology.

Stage 2 proves challenging for vendors
'Surprised by the complexities' of the new requirements, some EHR makers have 'certification fatigue'
October 23, 2013, Diana Manos, Anthony Brino

“It has been a slow start," said Alisa Ray, executive director and CEO of the Certification Commission for Health Information Technology, of EHR vendors' readiness for Stage 2 meaningful use. "They’re working hard. They’re struggling a little bit."

That stands to reason, considering that, when comparing Stage 1 to Stage 2 certification, technology developers are "navigating a higher bar and increased complexity," she said.

As the end of 2013 closes in, most federal certification bodies are noticing an uptick in the number of vendors who are applying to become certified under the 2014 criteria — the same criteria that will be required for the EHR products providers must use to attest to meaningful use Stage 2.

But not all of them are finding the process to be a cakewalk. Ray said there are three areas of Stage 2 that are proving the most challenging for certification: clinical quality measures, interoperability, and automated measure calculation for reporting metrics.

Automated measure calculation “requires almost a whole day of testing,” she said. “There are just a lot fewer products than were there with the Stage 1 or 2011 criteria.”...

And without naming names, Ray said that “almost everyone has struggled and been surprised by the complexities,” and a number of them have had to go through several certification trials, after not meeting certain criteria. “There are companies that have been testing every year since 2006 with the CCHIT programs; it’s not like they’re novices. And when they get into it, there’s a new wrinkle or something they may not have anticipated or configured correctly.”

It’s important to keep in mind, she said, that it’s a combination of the criteria and ONC’s testing methods that really defines “the exact nuances of what the product needs to be able to do.”...
Maybe we should put CGI Federal on it. They don't seem to have been real busy of late.

But wait! There's more! From THCB:
...According to Modern Healthcare, natural selection may already be taking place in the EHR environment as Meaningful Use 2014 and Stage 2 introduce more exacting requirements. The magazine’s review of federal records shows a massive drop in the number of health IT systems being tested for Stage 1 2014 and Stage 2 certification.  While around 1,000 EHR technologies were certified for 2011 Stage 1 requirements, as of last week only 79 systems were certified for 2014 standards. Almost all companies are scrambling. Some will get certified in time. Many more won’t.

“This is just the beginning of the shakeout … there is an asset bubble in electronic health records and health IT,” said Dr. David Brailer, founder and CEO of Health Evolution Partners and former head of the Office of the National Coordinator for Health Information Technology.

“The data suggests that it is likely we’ll see a sizable reduction in the number of EHR vendors listed for 2014 edition certification,” predicted Steven Posnack, director of federal policy, and Dustin Charles, a public health analyst, on the ONC’s September 13 blog post...

UPDATE: Nice, from Jim Tate, Healthcare IT News
What not to do in a meaningful use audit
6 things to avoid if you want to protect those incentive payments
October 21, 2013

  • Having no one in charge. Assign a committee to be responsible for the audit process and requests for documentation. When things go wrong there will be plenty of people to blame.
  • Having insufficient documentation. Just assume you can always go back and recreate reports that you can't find. All that data is in there somewhere, I'm sure we can find it if we need to.
  • Ignoring requirements. We are not really sure what is this "syndromic surveillance submission" business. We only have to do one test? Let's just say "yes" and move on.
  • Having an undocumented MU strategy. What was the reasoning behind those core measures that were excluded and menu measures that were not chosen? Who was that staff member that made the decisions?
  • Blaming the EHR vendor. This entire mess was created by our vendor. It is their job to make sure there are no problems. They should be responsible and make this go away.
  • Failing to perform a Security Risk Assessment. I'm pretty sure we did one of these a few years back and it was OK. Probably still good now.

More on the topic:
Meaningful Use attesters: Beware the False Claims Act
October 17, 2013 By Marla Durben Hirsch

We know what the drill is when providers attesting to Meaningful Use are later audited to see if they really were entitled to their incentive payments. If auditor Figliozzi and Company determines that the provider did not meet the attestation requirements, the provider will receive a letter directing it to return the "overpayment" to the government within 30 days to avoid having to also pay interest. If the debt still is not paid within 60 days, the debt is referred to the U.S. Department of the Treasury for possible offset.  A number of people who have dealt with these audits have shared the details of the letters used; the Centers for Medicare & Medicaid Services even provides some information on its website...

...CMS does state in the regulations that it believes that attestations are subject to the False Claims Act. This issue is particularly sticky because Meaningful Use is an "all or nothing" deal; if one component of the attestation is faulty, the provider must return all of the money. No partial credit...

The False Claims Act is not to be taken lightly. Penalties range from $5,500 to $11,000 per claim, and are subject to treble damages. The U.S. Department of Health & Human Services has recovered millions of dollars from providers by using the False Claims Act. Moreover, it allows individuals to become whistleblowers and bring their own action against a provider, receiving a percentage of the amounts recouped. This leave providers particularly vulnerable.

We already know that improper billing by EHR users is on the government's radar. I would not be surprised if the government also starts using the False Claims Act to go after improper attestation...
I'd like to know the extent of MU audit failures triggering Incentive paybacks.
31 USC § 3729 - False claims

(a) Liability for Certain Acts.—

(1) In general.— Subject to paragraph (2), any person who—

(A) knowingly presents, or causes to be presented, a false or fraudulent claim for payment or approval;

(B) knowingly makes, uses, or causes to be made or used, a false record or statement material to a false or fraudulent claim;

(C) conspires to commit a violation of subparagraph (A), (B), (D), (E), (F), or (G);

(D) has possession, custody, or control of property or money used, or to be used, by the Government and knowingly delivers, or causes to be delivered, less than all of that money or property;

(E) is authorized to make or deliver a document certifying receipt of property used, or to be used, by the Government and, intending to defraud the Government, makes or delivers the receipt without completely knowing that the information on the receipt is true;

(F) knowingly buys, or receives as a pledge of an obligation or debt, public property from an officer or employee of the Government, or a member of the Armed Forces, who lawfully may not sell or pledge property; or

(G) knowingly makes, uses, or causes to be made or used, a false record or statement material to an obligation to pay or transmit money or property to the Government, or knowingly conceals or knowingly and improperly avoids or decreases an obligation to pay or transmit money or property to the Government,

is liable to the United States Government for a civil penalty of not less than $5,000 and not more than $10,000, as adjusted by the Federal Civil Penalties Inflation Adjustment Act of 1990 (28 U.S.C. 2461 note; Public Law 104–410  [1] ), plus 3 times the amount of damages which the Government sustains because of the act of that person.
"knowingly presents or causes to be presented..."



The Digital Health Conference brings together a diverse group of professionals for two days of lively intellectual exchange.

Healthcare providers, IT innovators, health leadership, start-ups, hospital officials, group practice managers, investors, and entrepreneurs will gather to hear insights, ideas, and analysis from leaders in the health IT community.

Engage with thought-provoking lectures, interactive panels, emerging IT tools, technological exhibits, networking and discussion.

The event will be held at the Hilton New York, in the heart of Manhattan, and will showcase practical, innovative, and inspiring advancements in health information technology.
They've granted my press pass. I'm registered and booked.

Written Testimony of Cheryl Campbell, Senior Vice President CGI Federal Inc.
Prepared for
The House Committee on Energy and Commerce Subcommittee on Health
September 10, 2013

Chairman Pitts, Congressman Pallone, Members of the Committee, thank you very much for the opportunity to appear before you today. My name is Cheryl Campbell and I am a Senior Vice President at CGI Federal Inc. (CGI Federal), a company that has provided information technology (IT) and business process services to the federal government for more than 36 years. In my role, I lead CGI Federal’s Health and Compliance Programs Business Unit, including responsibility for all of its projects at the Department of Health and Human Services (HHS) and several other federal agencies. It is my pleasure to appear today before you at this hearing to discuss CGI Federal’s role as the contractor designing and developing the complex, IT application known as the Federally-Facilitated Marketplace (FFM), formerly known as the Federal-Facilitated Exchange. The FFM application, one of several components being developed in a multi-stakeholder environment, will allow citizens, health insurance issuers, the Centers for Medicare and Medicaid Services (CMS), and many States to participate in the marketplace for affordable health insurance mandated by the Patient Protection and Affordable Care Act (PPACA).

On September 30, 2011, CMS conducted a competitive procurement and selected CGI Federal to design and develop the FFM. CMS issued CGI Federal a task order for this work under CGI Federal’s Enterprise Systems Development, Indefinite-Delivery, Indefinite-Quantity type contract. Currently, the task order includes: a 29-month Base Period for design, development, and implementation; one (1) 6-month and two (2) one-year Option Periods for operations and maintenance; and a 6-month Transition Out Period.

The task order directs CGI Federal to design and develop a FFM that will perform the functions and business processes that CMS has identified in regulations and guidance issued pursuant to the PPACA. At the time of task order award, most of these regulations and guidance were still being finalized and the associated system requirements defined fully. For that reason, the FFM task order was issued as a cost-reimbursement type task order and the project’s original scope was defined broadly with deliverable dates to be determined by CMS. During the course of performance, CMS has modified the task order on several occasions, generally in response to more detailed requirements regarding system functionality as regulations and policy were better defined.

Generally, CGI Federal’s scope of work includes the following three (3) work streams:
1)    Architecting and developing a FFM that may be used by any State that opts out of building and operating its own marketplace;

2)    Designing an IT solution that is adaptable and modular to accommodate the implementation of additional functional requirements and services; and

3)    Participating in a collaborative environment and relationship in support of the coordination between CMS and its primary partners.

When open enrollment begins on October 1, 2013, the FFM will have three (3) key functions to assist citizens in comparing, selecting, and enrolling in qualified health plans in States that have chosen not to build their own marketplace. These three (3) key operational functions include:

1)    Eligibility & Enrollment. The FFM will serve as the “front door” for consumers to fill out an online health insurance application, determine their eligibility for health insurance, and enroll in a qualified health plan. Among other things, the FFM will interface with a Data Services Hub being developed by a contractor under another contract to access income, citizenship, and the information necessary to determine an individual’s eligibility for health insurance, and whether that individual also is eligible for subsidies or credits. The FFM also will allow citizens to view, compare, select, and enroll in health plans available through the exchange.

2)    Plan Management. The FFM will serve as the entry point for health insurers to submit plans for CMS certification as qualified health plans. CMS will use the FFM to acquire, certify, and manage issuers offering qualified health plans through the FFM. CMS also will coordinate plan management activities with States, including monitoring and oversight, account management, and recertification. Health insurers began submitting their plans to the system in April 2013.

3)    Financial Management. The FFM will allow CMS to manage financial transactions with issuers, including calculating reinsurance payments, risk adjustments and corridors, and premium processing.

Under CGI Federal’s task order, CMS is responsible for establishing the business processes and general requirements for the FFM system and CGI is tasked with designing and developing an IT architecture to achieve these requirements. The business processes and general requirements come from the PPACA and regulations, policy, and guidance issued by CMS, CMS’ requirements contractor, and other Federal agencies and are influenced by the diverse approaches individual States have adopted to implement the law. To that end, the IT solution has been structured to support CMS as it provides three (3) implementation model options to the States. In the most basic terms, these three (3) options are:

1)    Federally Facilitated Marketplace – HHS operates the marketplace for a State;

2)    State Partnership Marketplace – A State operates plan management or customer support or both and HHS operates the remainder of the marketplace for that State; and

3)    State-Based Marketplace – A State operates the entire marketplace, but has the option to use HHS Support for certain activities.

To date, the FFM implementation has achieved all of its key milestones from the initial Architecture Review in October 2011 to Project Baseline Review in March 2012 and, most recently, the Operational Readiness Review in September 2013. Additionally, in April 2013, health insurers began submitting their plans to the system for review by CMS. Starting in August 2013, consumers were able to go into the system and register their accounts.
At this time, CGI Federal is confident that it will deliver the functionality that CMS has directed to enable qualified individuals to begin enrolling in coverage when the initial enrollment period begins on October 1, 2013.
Moving forward, CGI Federal also is confident in its ability to deliver successfully on its task order and remains committed to the success of the FFM as a key mechanism for providing health care coverage by the statutory deadline of January 1, 2014. I appreciate the opportunity to appear before you today and would be pleased to answer any questions that you may have.
"At this time, CGI Federal is confident that it will deliver the functionality that CMS has directed to enable qualified individuals to begin enrolling in coverage when the initial enrollment period begins on October 1, 2013."

Pass the popcorn.

Scroll back down through my prior post. See also, from Kaiser Health News:
Defending Health Exchange's Rollout Puts Sebelius In Hot Seat


The White House is sending in teams of experts to fix badly broken The project has 55 contractors. Sending in SWAT teams of politically connected individuals who know nothing about the project but want it fixed NOW is a recipe for more disaster....

Read the entire piece. Excellent.

More to come...

Friday, October 18, 2013

Federal default averted for now, time to fix the HIX mess before the next DC standoff in January

Well, that was a 24 billion dollar waste of time and money we don't have.

We'll see come January 2014 whether they'll do it again. Meanwhile...

"For the past two weeks,, the federal government’s new health insurance marketplace, has been bogged down by problems, preventing users ... from viewing insurance options and plans on the website.

Federal officials have pointed to overwhelming demand to explain the site’s problems. But web developers, other experts and journalists have uncovered more fundamental issues with the design and functioning of the site..."
A great read. This linked story is my fav:
How The First Internet President Produced The Government’s Biggest, Highest-Stakes Internet Failure
Obama ran a perfect digital campaign — but he couldn’t control the federal contractors. Now imperils ObamaCare.

Once upon a time, Senator Harry Truman held the feet of wartime contractors to the fire, charging them of profiteering from producing the “arsenal of democracy” during World War II in hearings broadcast to the nation. Today, the scandal is not a warship that isn’t seaworthy, a plane that doesn’t fly, or rotten food. It’s a website,, that has not delivered on its mission of enabling millions of Americans to browse and enroll in health insurance plans.

The debacle is merely the most visible example of how $80 billion spent annually by the federal government on information technology falls far short of delivering the quality or service any private company would expect at a fraction of that cost.
And while this is the first time many Americans have become aware of the issues that pervade federal IT architecture, it’s hardly the first time that a federal government IT project has run far over cost and then not worked particularly well. In the wake of the botched launch, opponents of the Affordable Care Act are blaming the federal government itself, suggesting that this just simply shows the government cannot deliver on a project. But they would be wrong to do so.
At the heart of the federal IT crisis is a complex system of regulations that rewards contractors that are better at bidding on giant federal contracts than at building software. While the political figures who commission or oversee those contractors are ultimately culpable, the work itself is done by the private sector. That’s not only true of civilian agencies, as the world was reminded when a private contractor for the National Security Agency, Edward Snowden, leaked key documents from the government and gave then to the press.

In fact, over the past several decades, more and more core information technology functions have been delivered by private contractors, not in-house staff. While a few government executives look for different approaches, private contracting is now the norm when it comes to how government IT is proposed bought, built, and maintained.

Given how well the Obama campaign used technology to support getting the Democratic nominee for president elected, I’ve seen many people wondering how his administration has so badly botched the technology behind his signature legislative achievement...
Matthew Holt at THCB is on it.
A Pragmatic Fix for & the HIXs

By now even those of us who originally thought that we were seeing minor teething troubles are no longer deluding ourselves., the federal health insurance exchanges (HIXs), and many of the state HIXs are in deep trouble.

One summary of many articles about this is up at ProPublica. But now that the House Republicans have stopped trying to destroy the country and themselves, attention will turn quickly to this problem, and–much worse–beyond the politics, there is now only eight or so weeks to get ready for actual enrollments for Jan 1, once you take out Thanksgiving and the Christmas holiday. Getting ten or twenty million new customers on board, not to mention the small businesses who want to move from their current insurance onto the exchanges, seems like an impossible task...
 Yeah. What did I say here back in August?
Forget "HIT." Forget "Meaningful Use" and "REBOOTING" (or just "BOOTING") it. Forget "HIE." Up next? "HIX" -- the PPACA "Health Insurance Exchanges" that comprise a critical next step in the operational implementation of "ObamaCare" (or, as I sometimes call it, "AHIPcare," which is what it mostly is).

Hard right "Republicans" have vowed to obstruct (or, preferably, kill) the ACA, vowing to cause a federal debt default and government shutdown on October 1st if necessary to "defund ObamaCare" -- which, tactically at this point means, as a priority, throwing truckloads of sand in the HIX gears and cause insurance exchange failures at every turn.

Should be "interesting."

I would think that, for now, Health IT is off the radar, "REBOOT" Congresscritters notwithstanding. HIT is chump change relative to the money at stake in the PPACA.

Money quote from the Buzzfeed article:
[T]his debacle is incredibly embarrassing for the president and his administration. It’s given huge political ammunition to the opponents of the Affordable Care Act and unfortunately further damaged the trust and the government’s ability to accomplish big things throughout the country. It’s not clear if the tech will be able to be fixed in time for the second stage of people rushing to get insurance before the deadline.

It would be a historic irony if an administration that was elected using cutting-edge technology applied in innovative ways could not carry that innovation into office in support of Obama’s signature legislative accomplishment. Unfortunately, unless something changes quickly, that’s how this rough draft of history will be coded.


Not pretty. First position, "above the fold." The supposedly "Liberal Lapdog" Huffington Post is giving the PPACA HIX debacle full play.

Noted medical economist J.D. Kleinke wrote a great comment under Matthew Holt's THCB post today:
...None of this should have been this hard, and this simplifying fix would go a long way to dealing with a problem created by an Administration working under political siege, well beyond the capacities of any government agency.

Along with benefitting greatly from the streamlining you suggest, this whole mess would have been avoided if (1) all the states had participated in the implementation of a law that was duly passed by Congress, and (2) we had been able to leverage the private exchanges the way you suggest across all states – and thus avoid having the federal government reinvent the wheel. We have had private exchanges in place and working for years, and not just the two you cite, but several others operated by benefits companies – and of course ExtendHealth, which has been enrolling Medicare beneficiaries for nearly a decade.

The fact that the Fed had to scramble to put a crappy exchange in place for 36 refusenik states is one very tangible example of what happens when people put politics ahead of policy – when making the President look bad becomes more important than making things work.

There are numerous technical reasons the Federal exchange is working like hell, when it’s working – but the underlying reason is political sabotage, plain and simple – from the same types who not that many days ago were willing to bring down the entire economy to make a political point.
I can't help but wonder about two things related to the PPACA HIX travail: [1] surreptitious GOP operative sabotage hacking, and [2] GOP funded "corporate espionage" -- i.e., planting "moles" amid the contractors' programmer workforce. Maybe that's tinfoil hat stuff, but nothing would surprise me anymore.

Should the Obamacare Exchanges Be Shut Down?

My sense is that the biggest reason Obamacare is now in trouble is because of the top-secret way in which the administration has handled the rollout. If they had developed the computer system in a transparent way, the marketplace would have told them long ago this would not work.

No one outside the inner circle at the Department of Health and Human Services has any idea what’s really going on behind the Wizard’s curtain. Hasn’t for months. Doesn’t now.
So any technical advice any of us could give would be, to say the least, uninformed.
If I were on the inside, and it were up to me, the first thing I would do is bring in a group of heavyweight information technology experts to tell me just what was really going on. The administration cannot trust the people who have been working on this because they told them to launch this mess on October 1 and almost three weeks in there has been no improvement on the website or in the backroom––they no longer have credibility...
The greatest threat to Obamacare right now is a computer system the Obama administration continues to defend. And maybe their inability to understand how much damage they are themselves doing to the President’s signature domestic accomplishment...
HELLO? CGI Federal? Larry Ellison? The 1990s just called. They want their database back.

Well, let's see... Expect House hearings, 'eh? The GOP will be calling for them this coming week, bet on it, with Sebelius subpoena'd to be put squarely on the hot seat. And, the President has just handed his more salivating foes an entire carcass of red meat for the next installment of Federal Shutdown and Default, coming our way in January.

Pressure mounts for Sebelius to testify about ObamaCare website problems

House Republicans are increasing pressure on Health and Human Services Secretary Kathleen Sebelius to testify about a litany of problems with the ObamaCare website in its opening weeks.

Leaders of the chamber’s Energy and Commerce Committee are pressing for public answers after the Obama administration and companies involved in the site's development and launch said the online health care exchange was “on track” for the October 1. start.

However, the site, which provides a menu of insurance plans for Americans in the 36 states without their own site, has instead been plagued by crashing under heavy user traffic, failing to let customers register or purchase plans and reportedly logging inaccurate information.

Committee Chairman Fred Upton began focusing on Secretary Sebelius after she went to Comedy Central’s “The Daily Show with Jon Stewart” last week to talk about the website.

“Secretary Sebelius had time for Jon Stewart, and we expect her to have time for Congress,” the Michigan Republican has repeatedly said..
Yep. What I said. More, from the gaudy, partisan NewsMax:
GOP Girds Loins for Testy Obamacare Hearings
Saturday, 19 Oct 2013 09:01 PM
By Todd Beamon

Capitol Hill Republicans are gearing up for hearings next week on the botched rollout of Obamacare — and the White House said on Saturday that about 476,000 health insurance applications have been filed through the new exchanges.

The figure is the most detailed yet from the Obama administration since the exchanged opened on Oct. 1 during the partial federal government shutdown.

Still, the officials refused to tell The Associated Press on Saturday how many people had actually enrolled in the insurance markets.

Without enrollment figures, it's unclear whether Obamacare is on track to reach the 7 million people projected by the Congressional Budget Office to gain coverage during the six-month sign-up period.

The officials did not want to be cited by name and would not discuss the health insurance rollout unless they were granted anonymity, the AP reported.

Since going online on Oct. 1, the main Obamcare exchange,, has been marred by technical glitches and cost overruns — leading technology specialists to conclude that the company hired to build the site, CGI, was not qualified for the job...
It will be certainly an interesting week. My weekend comment over on THCB:
Bobby Gladd says:
October 19, 2013 at 3:49 pm

I wonder if any of these contractors had the requisite HIPAA Omnibus-compliant BAA’s in place?

Wonder whether they had any software QA P&P’s in place?

(Asked and Answered)

I also can’t help but wonder whether there were any GOP supporter-paid “moles” hired by these contractors and artfully working to throw sand in the HIX gears?

Yeah, it really is a CusterFluck. Obama just handed the Defunder Battalion, — on a Bronze/Silver/Gold/Platinum Platter, no less — a convoy load of depleted uranium hollow point projectiles for the January 2014 Shutdown/Default Festivities.

Wonder whether Sebelius will get dragged before a number of congressional Circus Vargas committee hearings this coming week or next?

(Asked and Answered.)

Read the full post. Add your comments.

More to come...